Sunday, February 28, 2016

Oh Lordy, it’s The Fat Lags!

Alex Cavendish looks at the obesity problem in British prisons and suggests a means to tackle it. Alex Cavendish is a former prisoner. His writings on the prison system can be found on Prison UK: An Insider's View.
As an ex-prisoner who piled on the pounds while I was inside, I thought I should probably write a post about the obesity epidemic in our prisons. Despite the pun in my title, it’s actually no laughing matter. In fact, it is a ticking health time bomb that the over-stretched NHS is going to have to deal with for decades to come.

Chips with everything?

The problem is evident on almost every prison wing. As the prison population is ageing, so its collective waistline seems to be expanding. Jail jogging bottoms – which don’t flatter the fuller male figure at the best of times – can be seen stretched over expanded paunches and muffin-tops are everywhere to be seen, even on younger lads.

One aspect of the internal crisis caused by Chris Grayling’s ludicrous revision to Prison Service Instruction 30/2013, which forced all new arrivals in our prisons into prison-issue clothing for weeks or even months, was the sheer shortage of appropriate kit in the stores. For years, many male prisoners had worn (and paid for) their own clothes. As a result, the demand for a wide range of sizes in prison joggers, boxer shorts, t-shirts and sweatshirts had been manageable.

A tight fit, there mate...

From September 2013, however, all new prisoners, including those previously held on remand but now convicted, suddenly found themselves required to wear only prison-issue. In many prisons, the results were evident. Those on Entry Level or Basic were often issued with clothing that really didn’t fit in any meaningful way, shape or form. Extra extra large blokes struggled with medium-size boxers and joggers that left massive bellies overhanging and even bare flesh exposed. Dressing men like clowns from a third-rate circus is hardly calculated to soften the ‘shock and awe’ of the early days in custody.

Since my late teens, I’ve always had a tendency to put on weight. I’ve never smoked and I don’t drink alcohol, but food is definitely a guilty pleasure. In order to keep my weight stable, I’ve always needed to be careful about not eating too many carbs or fats and to hit the gym several times a week, which I did before I got sent down.

At 6ft 1” in height, I went into prison a reasonably trim 12.5 stone (175 lbs/79 kg) with a healthy BMI. I came out a few years later at around 16 stone (224 lbs/101 kg). On average I think I gained over 16 lbs per year.

Potential links between obesity and imprisonment are already the subject of research. In 2012, the medical journal, The Lancet, reviewed a study undertaken by the University of Oxford which examined diet, physical activity and obesity in prison populations. Their findings were that ‘in most cases, male prisoners are less likely to be obese than men in the general population’. A further research project was approved by the NHS in September 2013 (Study into the incidence, prevalence and causes of obesity in two prison establishments in the UK).

Of course, this isn’t just a problem in British prisons. There is a body of international research that points to a propensity among inmates to gain unhealthy weight while incarcerated.

Prison pizza... death on a plate?

Although prison food is supposed to be nutritious, there is often far too many carbs, fat, salt and stodge on the menu. Chips, cheap pizzas, white baguette rolls, greasy lasagnas topped with ‘cheese analogue’ (processed cheese substitute), crisps, biscuits, cake, white bread… In short, a dietician’s worst nightmare. Of course, prison budget cuts also play a part, since the daily allowance for the provision of three meals a day is around £1.85 per prisoner.

However, the spreading waistlines are also closely linked to the significant amount of junk food that prisoners – if they have money in their prison accounts – are able to purchase from the DHL-run canteen. Of course, this includes more crisps, a range of cheap biscuits, heavily sweetened fruit juices, bags of white sugar, chocolates, jam, long-life cake and various other types of processed or preserved foodstuffs. Not to mention cheap, sugary fizzy drinks in cans or plastic bottles.

What makes all this junk food into a highly toxic threat to health is the sheer lack of activity for many prisoners. In some establishments, a significant proportion of inmates are locked behind their cell doors for 22 or even 23 hours each day as the outgoing Chief Inspector of Prisons, Nick Hardwick, has highlighted in his reports. Some men emerge only to take an occasional shower, to make a quick phone call or to queue to collect a tray of carb-rich food at mealtimes.

Of course, not all prisoners turn into tubs of lard. A fair proportion of prisoners do manage to keep themselves in reasonable shape, even in their cells, but that does require a degree of motivation and for many, boredom and depression soon extinguish any enthusiasm for keeping fit. One ex-prisoner who did manage it (and who blogs about his experiences on YouTube) is Jack Hill. You can find his video blogs and exercise routines here.

Exercising in a tiny cell: a challenge

Given the level of overcrowding across our prison estate, it can also be difficult for two (or even three) adult men who are locked in a tiny cell the size of an average bathroom to exercise. There simply isn’t room for two people to do press-ups or anything else unless one sits or lies down on his bunk.

I’ve just received a letter from a friend of mine who is a qualified personal trainer and who was a sportsman of some distinction before he ended up inside owing to a series of criminal acts of crass stupidity. He is currently residing in one of England’s worst Cat-B local jails and although he has been there since November, he hasn’t been allocated one single gym session. In fact, in nearly three months he hasn’t even had the compulsory gym induction course.

He and his cellmate – who also has an interest in keeping fit – take it in turns to use the tiny area of floor to do a programme of exercises three times a day. However, the fact that they are only getting two opportunities per week to shower, get little in the way of clean prison clothing during the weekly kit-change and the lack of opening windows in the cell mean that the atmosphere is getting pretty grim. The best they can do is a daily strip wash at the sink. Imagine living 23 hours per day in a stinking gym changing-room complete with a leaking, unscreened toilet and no cleaning products. I think you’ll get the general idea.

When the weather isn’t too bad they do get 30 minutes of exercise a day on a small enclosed yard, but as my mate has discovered, running or jogging is strictly prohibited on ‘health and safety’ grounds. Apparently, according to legend, a running prisoner once tripped up and fractured an elbow on the asphalt so anything more vigorous than a brisk walk is now banned.

Prison gym - standing empty & unused

Although every prison does have a gym, actually getting access to it depends entirely on having sufficient staff available to escort groups of prisoners from their wing or houseblock to the gymnasium. At present, some establishments are so shortstaffed that the once a week gym sessions are cancelled more often than not. The same prison hasn’t managed to organise one single visit to the library either since my correspondent hit the wing in November, so it isn’t just the gym that is standing empty and unused.

I have written previously about the crazy rules for gym access imposed nationally by Chris Grayling (link here). In a bid to curry favour with the Daily Mail and its sorry bunch of punishment freaks and armchair sadists, Calamity Chris decided that allowing inmates access to ageing and under-equipped prison gyms should be strictly rationed. These days, it’s rare to get more than one or two sessions timetabled each week and, even then, the moment there is an alarm on another wing or a few staff less than planned, gym sessions are cancelled.

This uncertainty over daily regime leads to rising levels of frustration which can, and do, spill over into fights and other types of violence. It is well-documented that exercise has a wide range of benefits for both mental and physical health, including reducing tensions and an increased sense of well-being. At a time when so many of our dysfunctional and understaffed prisons are teetering on the brink of violent disorder or worse, restricting gym sessions was probably one of the more idiotic of many daft and deeply damaging penal policies that Mr Grayling introduced during his term in office.

A strenuous workout helps

If I were Michael Gove, I’d look at getting as many prisoners into as many gym sessions as possible and to hell with what the Daily Mail writes about it. Inmates who have just enjoyed a strenuous workout in the gym, followed by a hot shower, will return to their wing ready for a meal, bang-up and a quiet evening of TV or sleep. They are much less likely to get into confrontations with officers or other cons.

Believe me, I’ve seen this at first-hand in six different jails and it works. Just ask yourself why boarding schools include so much sport and PE in the weekly timetable!

The alternative is to try to keep the lid on an increasingly tense and potentially violent population, many of whom have extremely poor anger management skills, using a depleted number of frontline staff. In my opinion, money spent on getting prisoners into gyms is never wasted, particularly when you consider the enormous cost of rebuilding trashed wings after a riot.

Even when tensions don’t erupt into violence, prisoners find other outlets for their frustrations and boredom. These include the use of drugs (legal and illegal), as well as snacking on junk food – which many health and nutrition professionals also identify as an addiction with psychological roots. The quick carb hit lifts the spirits, at least momentarily.

Prison canteen chocolate: Devil's fodder

The term ‘comfort eating’ was probably coined to describe what happens in prison cells up and down the country. People often turn to food when they are bored or feeling down. For those lucky enough to have faster metabolisms perhaps the evidence isn’t so visible in the short-term, but when combined with a lack of opportunities for vigorous exercise or work, the results can be toxic.

An ageing prison population is also more susceptible to a wide range of weight and obesity-related health risks, including type 2 diabetes, coronary heart disease, high blood pressure and certain types of cancer. Boredom and a lack of purposeful activity in prisons can indeed prove potentially lethal, or at least disabling.

I think the general public would be surprised, and perhaps shocked, to see the sheer numbers of overweight and obese prisoners of all ages dragging themselves around the landings, puffing as they climb the staircases and slowly killing themselves by gorging on crisps and chocolate bought at extortionate prices from the canteen. I’m not even going to mention smoking here beyond noting that an estimated 80 percent of adult prisoners also have a tobacco habit at present.

If you can pinch more than 6 inches...

Almost all of these prisoners will be released back in the community at some point. Many of them will come out with a range of health complaints or serious illnesses that could condemn them to a lifetime of requiring medical care or prescribed medication. A number will be deemed unfit for work and will require varying degrees of care for the rest of their lives.

Although some prisons do offer weight management clinics and ‘special diets’ can be prescribed by doctors, in my experience the take-up is often extremely limited. Most medical diets involve tiny portions of low-quality salad and fruit that will leave you feeling hungry, so they aren’t particularly popular. In one establishment they simply consisted of a handful of wilted salad served in exactly the same stale, white bread baguette as all the other meal options at lunchtime. I tried one, once. Most of it ended up in the bin.

Perhaps HM Inspectorate of Prisons should add a new category to its so-called ‘healthy prison tests’… an assessment of the physical and mental health of prisoners. Eating disorders are complex conditions to manage. However, there is plenty of scope for preventative measures (such as positively encouraging exercise and gym use), as well better education, healthier diets and a more appropriate range of food on offer from the canteen suppliers.

However, if we continue to lock two or more men in tiny cells for 22 or 23 hours a day for months or years on end, offer them high carb, high fat diets and deny them opportunities for regular, vigorous exercise, while at the same time providing canteen sheets packed with the most unhealthy snacks and junk foods imaginable, then as taxpayers, we’ll all be picking up the damages tab for years to come. Will anything change for the better? Sadly, I doubt it.

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Anthony McIntyre

Former IRA volunteer and ex-prisoner, spent 18 years in Long Kesh, 4 years on the blanket and no-wash/no work protests which led to the hunger strikes of the 80s. Completed PhD at Queens upon release from prison. Left the Republican Movement at the endorsement of the Good Friday Agreement, and went on to become a journalist. Co-founder of The Blanket, an online magazine that critically analyzed the Irish peace process.